Cumberland County 4-H Horse Program Mrs. C. Merle Dubs Member Award Application Information

Transcription

1 Cumberland County 4-H Horse Program Mrs. C. Merle Dubs Member Award Application Information A $ award will be presented to the winner of the Mrs. C. Merle Dubs Award Application Deadline: Applications and recommendation forms must be postmarked by September 1 or delivered to the Cumberland County Extension Office by 4:30 p.m. on September 1 Award Information This award is to recognize an outstanding a Cumberland County 4-H member active in the 4-H horse/horse science program. The emphasis of this award is on the member and his/her participation in the horse program, plus his/her leadership and impact on their club, county, and community. Application Criteria To apply for the Mrs. C. Merle Dubs Award, Cumberland County 4-H member must be years old as of January 1 of the current program year, and must be working to complete at least their third year of membership in the 4-H horse program. 4-H members currently enrolled in any 4-H horse project are eligible, and ownership of a horse is not mandatory for this award. Application Components To be considered as an award candidate, you must include the following items in your application: This award application form, completely filled out, with all required signatures One completed recommendation form from a 4-H leader or volunteer. One completed recommendation form from a non-4-h related individual (i.e. teacher, employer, coach, etc.) Application Deadline Applications and recommendation forms must be postmarked by September 1 or delivered to the Cumberland County Extension Office by 4:30 p.m. on September 1. The physical address and mailing address for the Cumberland County Extension Office is: 310 Allen Road, Suite 601, Carlisle, PA Revised: 3/2017

2 Mrs. C. Merle Dubs Member Award Application Score Sheet I. Project Summary 5 points II. 4-H Story 20 points III. Leadership 10 points IV. Community Service 10 points V. 4-H Events 20 points VI. Short Answer Questions (5 pts. each) 15 points VII. Recommendation Forms (5 pts. each) 10 points VIII. Completion and Neatness of Application 10 points Total Score 100 points Mrs. Merle Dubs Award - 2

3 Mrs. C. Merle Dubs Member Award General Information Name Address City State Zip Years in 4-H Age as of January 1 of this year Date of Birth / / Name of Parent(s) or Guardian(s) Name of 4-H Club(s) Name of 4-H Project Book Leader(s) Name of high school, college or vocational program _ Year in school If not in school, list your current job or career I have prepared this application and believe it to be accurate. Member's Signature Date My signature below indicates that I have read this application and believe it to be correct. I certify that this individual is a current member in good standing of the 4-H Youth Development Program, and approve this application. Parent or Guardian Signature Date 4-H Organizational Leader Signature Date Note: Recommendation forms should be completed by a 4-H leader or volunteer and another from a community-based individual (i.e. a teacher, coach, mentor, etc.). Please do not have a member of your immediate family complete a recommendation form for you. Mrs. Merle Dubs Award - 3

4 I. Project Summary (5 points) List the 4-H projects that you have completed this year and last year. Also, list the project that you are currently enrolled in for this program year. Be specific as to the project level or unit. Example: Level 1 Project Book, Junior Horse Production. Current Year: Year: Year: II. Mrs. Merle Dubs Award - 4

5 III. 4-H Story (20 points) Use the space provided below for a 1-2 page story of your accomplishments and experiences in the Cumberland County 4-H Horse Program. Please do not only relist all of your events and projects. Mrs. Merle Dubs Award - 5

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7 IV. Leadership (10 points) Describe one of the most important 4-H related leadership experiences you have had during your time as a 4-H member. Examples: Club Officer, Youth Liaison for the Cumberland County 4-H Advisory Council, Teen Leader or Camp Counselor, Teen Council Mrs. Merle Dubs Award - 7

8 V. Community Service (10 points) Describe one of the most important community service experiences you have had through a 4-H club or the 4-H program. Mrs. Merle Dubs Award - 8

9 VI. 4-H Events (20 points) List and describe county, district, regional, state or national 4-H events that you helped to plan or participated in. Also include your specific duties and any honors won. Limit to the last five years. (Please attach additional sheets, as needed.) Example: 2016 Hippology Competed at the York County Regional Competition placing individual 5 th and team placing 3 rd Competed at the Pennsylvania 4-H State Days placing 6 th individual and team placing 4 th Horse Quiz Bowl Competed at Ag Progress Days team placing 4 th Farm & Safety Quiz Bowl Competed at Ag Progress Days team placing 2 nd Competed at Farm Show team placing 1 st Cumberland County 4-H Horse Roundup Participated in showmanship placing 1 st Participated in Working Ranch Horse placing 2 nd Participated in Barrels placing 1 st District 4-H Horse Show Participated in Showmanship placing 2 nd Participated in Working Ranch Horse placing 3 rd Participated in Barrels placing 1 st State 4-H Horse Show Participated in Showmanship Participated in Working Ranch Horse Participated in Barrels placing 3 rd 2015 Cumberland County 4-H Achievement Night Received Outstanding Historian Received the I Dare You award Cumberland County Activity Day Served as Teen Leader Cumberland County 4-H Drill Team Participated during the PA Farm Show Participated during the Ag Expo Fair Cumberland County 4-H Horse Roundup Participated in showmanship placing 2 nd Participated in Working Ranch Horse placing 3 rd Participated in Barrels placing 1 st Mrs. Merle Dubs Award - 9

10 VII. Short Answer (15 points) Answer the following questions to best of your ability. Please limit your response to the space provided for each question. 1. What was the most important H of the 4 H s (Head, Hand, Heart, Health) to you during your 4-H experience, and why? 2. How do you believe the 4-H program will benefit you in your future endeavors? 3. What do you find to be the most important skill that you learned through the 4-H program? Mrs. Merle Dubs Award - 10

11 VIII. Recommendation Forms (10 points) Please have one recommendation form completed by a 4-H leader or volunteer, as well as one from a non-4-h related individual (i.e. teacher, employer, coach, etc.). On the next two pages you will find the recommendation forms. The completed forms can either be mailed directly to the Cumberland County 4-H Department at 310 Allen Road, Suite 601, Carlisle, PA (please include: Attn: 4-H Department) or submitted with your completed application. Mrs. Merle Dubs Award - 11

12 Cumberland County 4-H Mrs. C. Merle Dubs Member Award Reference Form Please select the rating that you believe best fits for each characteristic or skill listed for the 4-H member, with 1 being poor and 5 being outstanding. Any questions should be directed to the Cumberland County 4-H Department at H Member s Name In what way have you been affiliated with this 4-H member? How long have you been acquainted with this 4-H member? Personal Skills Poor Average Outstanding Not Observed Is confident Adjusts to new situations Has variety of interests Knows personal values Comments: Interpersonal Skills Poor Average Outstanding Not Observed Cooperative Tolerant of differences Sensitive to others Manages personal conflict Manages conflict with others Comments: Leadership Skills Poor Average Outstanding Not Observed Respected by peers Respected by adults Can guide peers Can solve problems Encourages teamwork Can delegate to others Asks questions, evaluates Invites change Comments: Additional Comments: Do you recommend this 4-H member to be selected for the Mrs. C. Merle Dubs award? Yes No Signature Date Phone number Mrs. Merle Dubs Award - 12